3.0T高分辨率磁共振血管壁成像及伪连续式动脉自旋标记技术在单侧烟雾病中的应用

目的 探讨3.0T高分辨率磁共振(HR-MRI)血管壁成像及伪连续式动脉自旋标记(3D-pCASL)技术诊断及评估单侧烟雾病(MMD)的应用价值。方法 对经DSA确诊的17例单侧MMD患者行3D-TOF MRA、HR-MRI及3D-pCASL检查。分析单侧MMD患者大脑中动脉(MCA)狭窄段管壁外缘面积,狭窄类型(偏心或向心性),管壁信号强度(均匀或不均匀)及狭窄段周围血管,评估单侧MMD脑血流灌注情况。结果 单侧MMD患者受累侧MCA狭窄段管壁外缘面积为(2.17±0.39)mm²,镜像侧为(6.11±0.37)mm²,二者差异有统计学意义(t=31.52,P<0.001)。17例单侧MMD患者均表现为单一受累MCA管腔均匀缩小或闭塞,管壁信号强度一致,狭窄段周围出现2个以上流空血管影,累及同侧颈内动脉(ICA)末端。受累侧MCA供血区(额颞叶)CBF值为(24.76±10.86)ml/min/100 g,低于镜像侧的(59.84±9.72)ml/min/100 g,差异有统计学意义(t=7.89,P<0.001),受累侧枕叶CBF值为(47.59±7.26)ml/min/100 g,镜像侧为(48.30±9.06)ml/min/100 g,二者差异无统计学意义(t=0.70,P=0.49)。结论 单侧MMD患者的HR-MRI表现具有一定的特征性,可提示诊断。3D-pCASL技术能反映单侧MMD患者脑血流灌注的基本情况,可用于临床评估与长期随访。

3.0T high-resolution MR vessel wall imaging and 3D pseudo-continuous arterial spin labeling in unilateral moyamoya disease

Objective To explore the application value of 3.0T high-resolution MR(HR-MRI) vessel wall imaging and 3D pseudo-continuous arterial spin labeling(3D-pCASL) in diagnosis and evaluation of unilateral moyamoya disease(MMD). Methods Seventeen unilateral MMD patients diagnosed by DSA underwent 3D-TOF MRA, HR-MRI and 3D-pCASL. The outer area of middle cerebral artery(MCA), stenotic vessel wall characteristics revealed by HR-MRI, including signal intensity(homogeneous or heterogeneous), stenotic type(concentricity or eccentricity) and stenotic segment collateralization were observed, and cerebral blood flow(CBF) in bilateral cerebral cortex area by 3D-pCASL were assessed. Results Unilateral MMD patients displayed a smaller outer area in the stenotic portion(mm² for affected side vs mm² for the mirror side, t=31.52, P<0.001), In 17 patients, the concentric narrowing or occlusion, the signal intensity of the stenotic vessel wall was uniform, two and more visible flow voids were present around the MCA stenotic segment and involvement of the terminal of internal carotid artery(ICA) were common. The CBF value(ml/min/100 g) in affected area of MCA blood-supply were significantly lower than that in mirror side ml/min/100 g, t=7.89, P<0.001). The difference of CBF value(ml/min/100 g) in affected side occipital lobe cortex area compared to the mirror side(ml/min/100 g) was not significantly different(t=0.70, P=0.49). Conclusion Unilateral MMD has certain characteristic HR-MRI findings. which could suggest the diagnosis. The cerebral perfusion in the unilateral MMD could be evaluated by 3D-pCASL, and 3D-pCASL could be used in the clinical evaluation and following-up.